Blog - Shilpa Bhouraskar

Being "Present" for your client -Part 2

The Magic of Case Taking

It is interesting that with the best of intention our patients just cannot give us all the information that is required during a homoepathic case taking process.

This was our first realisation as homoeopathic students when we struggled to fill pages of information into our thick booklets that we were required to complete as a part of our clinical training. Although it got easier to get the patient talking with practice, it was an uphill task to get quality information at times.

I remember how after spending an hour or so with the client and having ensured that we had extracted every bit of information that was possible we came back into the consulting room eager to get some feedback and watch the next part!

The supervisor would look at the notes and simply touch upon one or two key issue and suddenly the patient seemed to have reenergized! The case flowed once again. The whole dynamics changed and now the same patient gave so much more relevant information and keynotes!

This was possibly the best thing I ever got from those clinics. It was the inspiration to create similar magic in our own clinics. Something I would not get from books or theories but from just listening and watching that dynamics in action and having that interaction with our supervisors after the patient left.

What did we miss?

I often wondered what did we really miss during our consults. We asked the "right" questions and used the "right resources but something was missing. Slowly I started understanding the finetuning process of the casetaking process. Those subtle clues which the patients gave us repeatedly that we simply ignored because we were just not “present”.

We may have been caught up with our own insecurities or standards of perfection. We may have considered a certain area to be more important based on our own prejudice and the case may have gone in cricles without getting any deeper. So eventually we got pages of information but no real content!

I also learnt to pick the areas where there was a lot of juice in the case. These were easily overlooked if I did not clear that noise in my head and "truly" listened. It took time to be able to put that into practice before my case taking got better.

So when I was a supervisor myself it was interestingly to find my role reversed. It was a huge responsibility to offer what I got as a student! I could see similar confusion and frustration written on the faces of my students when I asked a particular question or chose a specific area to explore.

It was important for me to explain my own thought process behind every question I asked when we discussed the case later. It was hard at first to get my exact thoughts into words but I realised it was such a mutually beneficial process. Together we realised the pattern of what worked well and what did not.

Soon it became very clear that casetaking was not meant to be a linear process. Although there was a system and a framework at the foundation, you need to trust your instincts, "be" and let go. No question was right or wrong. It was all about what question was more efficient or not. Better still when was no question necessary. The best information came in the "pauses"

This has inspired me to create my ongoing video course on casetaking and analysis using many such experiences I gathered as a supervisor and a mentor.
Through this course I love sharing this fine tuning from my own real life cases. For me its all about finding the pattern in these hidden links and being aware of the juicy bits in the casetaking process beyond theory.

To give you an example let's have a look at the case of arthritis taken by a student during my supervision. We started with this case last time so I am thankful for all the comments I received through the month.

If you are watching this space for the first time, you may wish to click here to watch Part 1 of this blog where the case was introduced before watching this video.

This video is all about exploring the hidden links.

Discussion:

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Thank you Shilpa. It shows how beautiful the theme of the case can unfold when you sit and allow the patient to express themselves fully. I agree with you.... I would have asked more questions when there was any kind of substantial silence, but then would have missed the all important points that she made. In my own conclusions, these were: that she loved the security of her home and family, that security she so obviously wanted and needed, and feeling the need for others to provide that for her (hence your original decision on Calc.Carb if you had stayed with stage I and II.) But she also loved the travel aspect and connecting with others, chatting, talking, etc. And this clearly represents the Phosphorus element. But it was wonderful how she expressed the desire to travel and connect, but then to go home, back to her security, and that could then only have been Calc.Phos.

Thanks Shilpa. This was a great tuition. I agree with you, it's so easy to keeping asking questions, instead of just listening and letting the wholeness and completeness of the story unfold. And I realise that this is often what being fully present for your patients is really all about. Less of letting the mind jump in to try to analyse, and more of just listening and allowing the patient's thought processes and feelings and their story to naturally unfold.

Thanks again for illustrating this important point so beautifully.

It's lovely to read your insight further into the remedy Carolyn. Thanks for bringing that connection between its elements together.

That was a great lesson. It's hard not to keep asking... I have to keep reminding myself to button up my mouth. How did you know not to go to stage 4 questioning?

Thanks Madeleine. That is such a good question. Not sure if I can answer it as well.
It would have been quite possible she would have gone all the way to Stage 4 from another entry point or in a different time, place or situation.

One example comes to mind is when she was talking about the chief complaint possibly focusing on her fear of it going to her hip joints would have taken us there.

However the case took a different turn and then you simply go with her flow from there. Ultimately it will lead to the same center.

Also that it was difficult for her to directly get in touch with her fears and dreams was a subtle clue.

But the most important part was that the remedy was clear at Stage 3 so in a way there was no need to do anything more.

I am new to your blog and I must say I enjoy the way you present your cases in a logical progression. Thank you for the insights

Thanks Peter. You may wish to read my free ebook - Quest For Simillimum on this page where I have explained this process in detail through stages.

Great explanation! Looking forward to many more interesting discussions and cases..

Really interesting thank you.
When you got the information about get family, did you choose a rubrics for it? What did you choose?

Thanks for asking Misbah.
When I asked about family she confirmed what her real issue was - it was about not wanting to be lonely and then even though she loves travelling she has the desire to be safe and at home.

So the rubrics were Company desire for, Homesickness nostalgia and Desire to travel. Finally the peculiar rubric that confirmed the remedy was home go desire to ; go out, when they

Hi
Please can you send the video links again I am not getting any videos,many thnks.

Thanks Shilpa
Yes a tubercula miasm love of travel and calc phos has this love of travel.goes from place to place.with that phos eliment of socialising..great case taking .